These words are rather grandiloquent, and chosen to be so. I guess it is another way to catch one's attention without putting in big letters: S-E-X. These words are the terrible trio of moral transgressions that I believe torment our profession today.
I know the responses I'll get from some in the profession. Perle, you hate chiropractic, so why don't you leave? If I hated chiropractic, I would. I know I can make a lot more money teaching in the local school district. I'm passionate about cleaning up our problems because I love this profession so much.
To quomodocunquize is to make money by any means possible. The business of health care and in particular, chiropractic business, has never had it harder. We know managed care organizations are limiting our reimbursement, cutting the procedures covered and the diagnoses they will pay for chiropractors to treat. In some cases, this has pushed some doctors over the ethical boundary from honest practice to full-fledged criminal ventures, to such an extent that chiropractors have been prosecuted under RICO statutes, similar to organized-crime families.
When I entered Texas Chiropractic College in 1979, for me and most of my classmates, chiropractic was, for want of a better term, a calling. We didn't go into this profession to make money; we did it to help people. Not that there is anything wrong with making money, except that there are some now who seem to have chosen chiropractic as the vehicle to enrichment, and patients are more or less the tool used to extract their desired riches. You know these people. They were your classmates in chiropractic college. They're the ones who'd say, "Ds and Cs make good DCs." All they needed was a GPA good enough to graduate and get to the Holy Grail: a diploma and a license to practice. Or was it a license to make or steal money?
I know, Perle, you're blowing it out of proportion. Try doing a Google news search with the words "chiropractor" and "fraud." You will find new cases weekly, and some people judge our whole profession based upon a minority of crooks. I know similar search results would come up if one looked for fraud perpetrated by people in the medical profession. There are two reasons I don't care how many MDs are busted for fraud: 1) I'm not an MD and don't write about medical ethics; and 2) Their profession has cultural authority, while ours is in need of it. And every chiropractor who steals and gets caught actually is stealing our professional reputations. They are stealing our good names.
An ultracrepidarian is one who speaks or offers opinions in subjects he or she knows nothing about. I'm sure some readers think this applies to me, and well it may. However, it is yet another problem some of our colleagues suffer from. There is the chiropractor in Pennsylvania who told the patient that getting her meninges balanced by adjusting would cure her epilepsy, and told parents of children suffering from Down's syndrome that it would make their kids normal. Or there is the chiropractor who treated a patient for thoracic spine pain for 180 office visits, without any change in symptoms, because the patient had syringomielia - which the chiropractor never found. Some of what we have been taught as students and in seminars is not only false, but also has given us an unreasonable level of confidence in what we believe and theorize, such that we think of those things as immutable facts. I think we see these things as immutable facts because of two desires, which Quine and Ullian wrote about in their book, The Web of Belief:
"The desire to be right and the desire to have been right are two desires, and the sooner we separate them the better off we are. The desire to be right is the thirst for truth. On all counts, both practical and theoretical, there is nothing but good to be said for it. The desire to have been right, on the other hand, is the pride that goeth before a fall. It stands in the way of our seeing we were wrong, and thus blocks the progress of our knowledge. Incidentally it plays hob with our credibility rating."
Boundary violation refers to going beyond the social boundary between a professional, the doctor and the layperson - a patient. There is no such thing as a consenting relationship with a patient. The balance of power is always in the doctor's hands and thus a patient never really is capable of consenting to a relationship. Again, try doing a Google news search for "chiropractor" and "sex." Foreman and Stahl1 found that chiropractors were 3.39 times more likely to be involved in a boundary violation case than MDs.
The Profession's Response
Professionals have a social contract with society, whereby society grants us much self-governance because we profess (the origin of the word profession) knowledge that is beyond what the layperson can understand. Thus, professions are self-regulating. Unfortunately, it does not appear we are adequately policing ourselves. The AMA boycott has given some of us a perpetual siege mentality. Some have come to view an attack, even when justifiable, upon any chiropractor as an attack on the whole profession. In fact, there have been chiropractors subjected to investigations who have specifically said that the investigation was not about their business practices, but was an investigation into chiropractic. If we don't police ourselves and turn in the fraud artist - turn in the doc who claims to have the ability to treat any and all conditions (even when beyond his or her scope and competence) and the sexual predator with a chiropractic license - we risk the public viewing our whole profession as deviant, rather than recognizing the few who quomodocunquize, who are ultracrepidarian, or who violate boundaries.
- Foreman SM, Stahl MJ. Chiropractors disciplined by a state chiropractic board and a comparison with disciplined medical physicians. J Manipulative Physiol Ther 2004;27(7):472.
Click here for previous articles by Stephen M. Perle, DC, MS.